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食管癌腹腔区域淋巴结转移特点及危险因素分析

Characteristics and risk factors of abdominal lymph node metastasis in esophageal cancer

摘要:

目的 分析胸段食管鳞癌腹腔区域淋巴结转移特点及影响其转移的危险因素.方法 回顾性分析2009年6月至2014年6月四川省肿瘤医院收治的586例经腹、胸手术胸段食管鳞癌患者的临床病理资料.患者均行食管癌切除及规范淋巴结清扫术,根据患者病变情况,选择经腹上区、右胸两切口或腹上区、右胸、颈部三切口手术方式进行手术治疗.单独清扫18、19、20组淋巴结,分离16、17组及胃小弯淋巴结.所有淋巴结标本分组送常规病理学检查.正态分布的计量资料以(x)±s表示.计数资料以率表示,两样本率比较采用x2检验、多个率之间的比较采用x2分割法,多因素分析采用Logistic回归模型.结果 586例患者共清扫淋巴结12 524枚,(20±11)枚/例;淋巴结转移率为55.63% (326/586).清扫纵隔淋巴结7 012枚,(12±5)枚/例;纵隔淋巴结转移率为40.96%(240/586).清扫腹腔淋巴结5 512枚,(9±8)枚/例;腹腔淋巴结转移率为31.74% (186/586).胸上、中、下段癌腹腔淋巴结转移率分别为13.73%(14/102)、31.51%(92/292)、41.67% (80/192),3者比较,差异有统计学意义(x2=25.91,P<0.05).16、17、18、19、20组及胃小弯淋巴结转移率分别为12.80%(75/586)、16.89%(99/586)、1.71%(10/586)、0.68%(4/586)、1.71%(10/586)、2.05% (12/586),6者比较,差异有统计学意义(x2=287.95,P<0.05).单因素分析结果显示:肿瘤部位、手术方式、T分期、N分期、G分期、病理学分期、纵隔淋巴结转移是影响食管癌腹腔淋巴结转移的危险因素(x2=24.02,23.97,37.87,136.85,38.79,7.70,154.27,P<0.05).多因素分析结果显示:肿瘤位于胸下段、N3期及病理学分期为Ⅳ期均是影响食管癌腹腔淋巴结转移的独立危险因素(RR =5.80,2.36,2.76,95%可信区间:1.022 ~ 1.813,1.317 ~ 3.950,1.652 ~ 12.351,P<0.05).结论 食管癌腹腔淋巴结转移常见,以16组和17组淋巴结转移为主,胸下段、N分期和病理学分期较晚的食管癌易发生腹腔区域淋巴结转移.

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abstracts:

Objective To investigate the characteristics and risk factors of abdominal lymph node metastasis in thoracic esophageal squamous cell cancer.Methods The clinical data of 586 patients with thoracic esophageal cancer who underwent surgery via transabdominal and transthoracic approaches between June 2009 and June 2014 at the Sichuan Cancer Hospital were retrospectively analyzed.All the patients received resection of esophageal cancer and lymph node dissection, and the transabdominal right thoracic approach or cervico-thoracicabdominal triple incision was selected according to the condition of patients.No.18, 19, 20 lymph nodes were dissected seperately and No.16, 17 and lesser curvature lymph nodes were separated.All the specimens of lymph nodes were detected by regular pathological examination.Measurement data with normal distribution were presented as x ± s and count data were described as rate.Comparisons of rate between 2 specimens and among the multiple specimens were respectively analyzed using the chi-square test and partition of chi-squared.The multivariate analysis was done using the logistic regression.Results The number of lymph node dissected in 586 patients was 12 524 with an average number of 20 ± 11 per case, and the rate of lymph node metastasis was 55.63% (326/586).The number of mediastinal lymph node dissected was 7 012 with an average number of 12 ± 5 per case, and a rate of mediastinal lymph node metastasis was 40.96% (240/586).The number of abdominal lymph node dissected was 5 512 with an average number of 9 ± 8 per case, and a metastasis rate was 31.74% (186/586).The abdominal lymph node metastasis rate of the upper, middle and lower thoracic esophageal cancer were 13.73% (14/102), 31.51% (92/292) and 41.67% (80/192), respectively, showing a significant difference among the above 3 indexes (x2 =25.91, P < 0.05).The lymph node metastasis rate in No.16, 17, 18,19, 20 and lesser curvature lymph nodes were 12.80% (75/586), 16.89% (99/586), 1.71% (10/586),0.68% (4/586), 1.71% (10/586) and 2.05% (12/586), respectively, with a significant difference among the above 6 indexes (x2 =287.95, P < 0.05).The results of univariate analysis showed that the tumor location,surgical procedure, T stage, N stage, G stage, pathological stage and mediastinal lymph node metastasis were risk factors affecting abdominal lymph node metastasis of thoracic esophageal cancer (x2 =24.02, 23.97, 37.87,136.85, 38.79, 7.70, 154.27, P < 0.05).The tumor in the lower thoracic portion, N3 stage and stage Ⅳ were independent risk factors affecting abdominal lymph node metastasis of thoracic esophageal cancer in the multivariate analysis (RR =5.80, 2.36, 2.76, 95% confidence interval: 1.022-1.813, 1.317-3.950, 1.652-12.351, P < 0.05).Conclusions Abdominal lymph node metastasis is common in thoracic esophageal cancer in which No.16 and 17 lymph nodes predominate, and it is easy to occur in patients with lower thoracic esophageal cancer, and advanced N stage and pathological type.

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作者: 谢天鹏 [1] 向润 [1] 崔岳 [1] 杨晓军 [1] 李强 [1]
期刊: 《中华消化外科杂志》2015年14卷12期 1002-1005页 ISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.1673-9752.2015.12.005
发布时间: 2016-01-08
基金项目:
四川省科技厅应用基础研究计划项目
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